Issues and answers

              ANATOMY OF A COMPLAINT
The basic mission of the Oklahoma
State Board of Medical Licensure and
Supervision is to promote the Health,
Safety and Well-Being of the citizens
(patients) of Oklahoma by requiring a
high level of qualification, standards and
continuing education for those who hold
licenses regulated by the Board. The
primary way the Board accomplishes
this—and the one well known to all
Oklahoma physicians—is by issuing
medical licenses after a meticulous and
comprehensive credentialing process.
For most Oklahoma licensees, initial
credentialing and subsequent routine
license renewal procedures are their only
contact with the Board.
Some licensees, however, will become
involved with the Board as it performs
another of its mandated functions - to
protect public health and safety by
investigating complaints against individuals
licensed by the Board.
Since the year 2000, the Board
receives on average some 490 complaints
a year. The vast majority of complaints are
initiated by telephone. Each call is directed
to a member of the Board’s Department
of Investigations and Compliance who
discuss the complaint with the caller.
Often the staff member must tell callers
that their grievances are outside the legal
and ethical jurisdiction of the Board. This
information, along with allowing the callers
to have their say, can mitigate many
complaints. Department of Investigation
staffers explain to each caller that, if
possible, they must submit their complaints
in writing, preferably using the complaint
form on the Board’s website, if they wish to
pursue matters further. Roughly half of the
callers submit a written complaint, which is
then officially logged in.
About 83% of complaints to the
Board come from the public; 4.4% from
physicians; 3.5% from state agencies;
and the rest from law enforcement and
courts, nurses, pharmacists, self-reporting,
hospitals, newspapers, license renewal
forms, the National Practitioner Data Bank,
the Federation of Medical Boards’ Data
Bank, and Board staff.
The majority of complaints that result
in open cases usually deal with quality of
care issues, over-prescribing or prescribing
without medical need, sexual misconduct,
alcohol and/or substance abuse, billing
fraud, and fraudulent license renewal.
When the Board receives a written
complaint, the complaining party is
sent written confirmation of receipt.
The complaint is then referred to the
Board’s Complaint Review Committee
for initial review. The Committee consists
of the Board’s Medical Advisor (a
physician), Executive Director, Director of
Investigations & Compliance, and Assistant
Attorney General. If the Committee
Continued on pg. 4
Vo l . 1 8
Summe r
2 0 1 1 Issues&Answers Board of
Medical
Licensure &
Supervision
this issue
Anatomy of a Complaint P.1
Boundaries P.2
I’m From the Medical Board P.3
Annual License Renewal P.4
Keeping Patients Happy P.4
New Medical Board Members P.5
Board Meeting Actions P.6
Filing a complaint
Call the Board’s Dept. of
Investigation:
(405) 962-1400
1-800-381-4519
or online at:
investigations@okmedicalboard.org
02
BOUNDARY is the current term
used to describe the point where
a doctor/patient relationship can turn
from being mutually satisfying and
beneficial to inappropriate and even
criminal.
Sexual misconduct and clinical
interaction with friends, relatives,
employees and business associ-ates
are boundary issues of great-est
concern to the Medical Board’s
Department of Investigations and
Compliance.
Physicians control all bound-ary
situations by the very nature
of the doctor/patient relationship.
Physicians are clearly in the power
position. Despite the frustrating en-croachment
of rules and regulations,
physicians remain Captains of the
Ship of Medicine. Their power drives
the system but comes with ever
increasing accountability.
Sexual Misconduct
It is never appropriate and
always unprofessional conduct for a
physician to be involved in a sexual,
romantic or dating situation with a
current patient. There are simply no
excuses or exceptions.
According to the American
Medical Association (AMA) Code of
Medical Ethics: “Sexual contact that
occurs concurrent with the patient-physician
relationship constitutes
sexual misconduct. Sexual or
romantic interactions between physi-cians
and patient may exploit the
vulnerability of the patient. Sexual
or romantic relationships between a
physician and a former patient may
be unduly influenced by the previous
physician-patient relationship. Sexual
or romantic relationships with former
patients are unethical if the physician
uses or exploits trust, knowledge,
emotions, or influence derived from
the previous professional relation-ship.”
It goes without saying that a phy-sician
must end the doctor-patient
relationship before entering any kind
of romantic or sexual relationship
with a patient.
When is it appropriate to begin
a relationship with a former patient?
According to the rules of the Oklaho-ma
Medical Board: “…a professional
relationship may take months or
years to end and in some cases may
never be terminated for purposes of
sexual contact. As long as there is
a perceived doctor-patient relation-ship
in the eyes of the patient, doctor
or the Board, the physician is at
risk for disciplinary action based on
sexual misconduct. Consent by the
patient shall be no defense. In view
of the unique relationship between
doctors and patients and of the
patient’s position of vulnerability and
dependence, consent by the patient
may be of little significance. It is the
physician’s responsibility to prevent
and/or terminate any patient-initiated
sexual contact. Failure to do so
places the physician, not the patient,
at risk for disciplinary action based
on sexual misconduct.” So, if the
relationship doesn’t feel appropriate
in all aspects, it probably isn’t.
The AMA Code of Ethics also
addresses sexual or romantic rela-tionships
between physicians and
“key third parties”: “Patients are
often accompanied by third par-ties
who play an integral role in the
patient-physician relationship… The
more deeply involved the individual
is in the clinical encounter and in
medical decision making, the more
troubling sexual or romantic contact
with the physician would be… Key
third parties include, but are not lim-ited
to, spouses or partners, parents,
guardians, and proxies… Physi-cians
should refrain from sexual or
romantic interactions with key third
parties when it is based on the use
or exploitation of trust, knowledge,
influence, or emotions derived from
the professional relationship.”
Friend/Relative/Employee
Interaction:
Most physicians enter the
profession for altruistic and humane
reasons.They want to help others
and certainly their own relatives
and friends. But long gone are the
days when physicians could write
prescriptions with impunity or treat
relatives and friends in casual or
informal settings. Doing medical
favors for relatives, friends and
employees can put physicians at
risk.
BOUNDARIES:
Captain of the ship or just
someone who can’t say no?
Page 2
“When is it appropriate to begin
a relationship with a former
patient? ”
(Physicians cannot write
prescriptions for Controlled
Dangerous Substances for
immediate family, i.e., spouses,
parents, children, brothers, sisters
and grandchildren; but they may
for nieces, nephews, aunts, uncles,
great grandchildren and great
grandparents, as long as a valid
physician/patient relationship exists.)
Writing prescriptions as favors
or to be “nice” can cause unwanted
problems and severe sanctions for
Oklahoma doctors. At virtually every
meeting of the Medical Board, a
physician(s) must explain aberrant
prescribing. Often the situations
involve prescriptions written for
family, friends or employees without
examinations or establishment of
records. Without records, physicians
can easily fall into the trap of
inappropriate or over prescribing,
sometimes resulting in tragic
consequences for both physician
and patient.
The Oklahoma Bureau of
Narcotics and Dangerous Drugs
(OBNDD) Prescription Monitoring
Program (PMP) is the best tool for
physicians to use to check their own
prescribing activity and drug utiliza-tion
by their patients. Oklahoma
physicians are encouraged to con-sult
PMP regularly. Physicians must
register and receive a unique PIN to
access the data. To register, call the
PMP Helpline, 1-877-627-2674 or
online at pmp@obn.state.ok.us.
While it is easier said than done,
physicians should also say “No” to
friends and employees seeking diag-noses
or prescriptions without formal
examinations. If you feel you must
say “Yes,” check with PMP and then
create a chart and make it a part of
the patient’s medical record. 
Page 3
I’m From The
Medical Board And
I’m Here To Help?
Once licensed, most physi-cians
will have little or no direct
contact with the Oklahoma
Board of Medical Licensure and
Supervision (Board) other than
to renew their licenses annually.
But in these litigious times of
often unrealistic expectations,
even the best physicians may
be sued or become subjects of
complaints.
So what’s a physician to do
when he or she receives a letter
or call from the Board about a
complaint or hears the recep-tionist
say “Doctor, there is an
investigator here from the Medi-cal
Board”?
First of all, don’t panic.
There are two sides to every
story. The Board’s Complaint
Committee instructs the Depart-ment
of Investigations and Com-pliance
staff to obtain all facts
pertinent to a complaint. The
Committee’s Medical Advisor is
a physician and the investigative
staff members are Registered
Nurses and/or trained law en-forcement
personnel. Their roles
are not adversarial. Their objec-tive
is to gather information. It is
important for the physician and
office staff to cooperate with the
investigators to get your side of
the story on the record.
While it is not necessary,
physicians have the right to be
represented by an attorney at
any time during the investigative
process.
Once the investigation is
complete, the Board’s Complaint
Committee determines if further
action is necessary.
Annual License Renewal
Questionnaire Reminder
Oklahoma physicians must renew their licenses every year. While this
annual process may be considered routine and sometimes delegated to staff
by many busy physicians, the Medical Board’s Department of Investigations
and Compliance encourages Oklahoma physicians to personally complete the
form. According to Title 435:10-7-4 (8) of the Oklahoma Administrative Code,
Unprofessional Conduct for which the Board may take disciplinary action,
includes “Fraud or misrepresentation in applying for or procuring a medical
license or in connection with applying for or procuring periodic re-registration
of a medical license.” A mistake by staff is not considered a legitimate excuse
for an incorrect renewal application.
The renewal application includes a series of “Yes/No” questions regard-ing
possible adverse civil, criminal, medical/legal and other practice related
actions that may have been taken against a physician since the last license
renewal. Whatever happened before then should be on record already with
the Board. For physicians with new Oklahoma medical licenses, the questions
pertain to the time since the license was granted initially.
Since nuance is so much a part of today’s medical/legal environment,
some physicians may feel compelled to seek advice of an attorney in answer-ing
the questions. Just as in the case of a staff member’s error, a lawyer’s
incorrect recommendation is not a safeguard against possible disciplinary
action.
Physicians should complete the renewal form themselves. If a physician
is unsure how to answer a question, call the Department of Investigations,
405-962-1400. The call can be handled anonymously.
And remember, only answer “Yes” if it happened in the last “license
year.” Otherwise, the answer is “No.” This will save the physician, of-fice
staff and the Board’s Department Investigations and Compliance
the time and inconvenience of following up on “Yes” answers that are
no longer pertinent.
Page 4
KEEPING PATIENTS
HAPPY
About half of all complaints received by
the Board fall outside the Board’s jurisdiction
and often have little or nothing to do with the
actual practice of medicine. Many complaints
involve the “business” of medicine and may be
avoided if patients are happy with the service
they receive both before and after they see
the doctor. Keeping patients satisfied has
never been more difficult than in this era of
complex rules, regulations and insurance
formulas.
Here are a few specific areas that cause pa-tient
dissatisfaction that usually can be easily
prevented.
Medical Records
While physicians own original medical
records, the information in them belongs to
the patient. Physicians are required by law to
provide copies of medical records to patients
upon request, except for certain psychiatric
cases. Physician offices may charge up to
$1.00 for the first page and $0.50 for each
additional page in the record. Medical offices
cannot withhold copies of a patient’s medical
record for any reason, even if the patient has
past due accounts with the office. If patients
request copies of medical records, accommo-date
them in a timely fashion.
Dismissing a Patient
Physicians do not need a reason to
dismiss patients from their practices. The
dismissal should be in writing with the letter
made part of the patient’s medical record. If
the patient is taking prescription medication,
the physician should write a prescription for
a 30 day supply of the medicine (except in
certain pain management situations, particu-larly
when the patient has violated his/her
agreement.) Remember, patients are entitled
to copies of their medical records.
Payment Issues
Physicians cannot withhold care from
patients with past due accounts who already
have scheduled appointments. However, phy-sicians
may subsequently dismiss these pa-tients
from their practices using the procedure
outlined above. Physicians should always
provide emergency care when necessary.
Vacation Coverage
If physicians will be out of the office and
not seeing patients for an extended period of
time for vacation, illness or other reasons, be
sure to arrange back-up coverage for patients
with another physician or leave instructions
with office staff or on electronic answering de-vices
referring patients to a local Emergency
Room or AM/PM Clinic.
concludes the complaint is
without merit, no action is taken.
The Director of Investigations
will write a letter to that effect to
the complaining party. These
cases do not become a part
of a physician’s public file but
they are kept in a confidential
investigative file unavailable to
the public.
If a complaint appears to
have merit, a case is opened
and assigned to an Investigator,
who is instructed to obtain spe-cific
information and is offered
general recommendations on
how to proceed with the investi-gation.
Physicians may retain legal
counsel anytime during the
investigative process.
The Board’s investigative
staff consists of three Regis-tered
Nurse Investigators (one
with special expertise in psy-chiatry,
another in OB/GYN) and
three law enforcement officers.
The Board has subpoena
power.
After the investigators
gather information and com-pile
evidence, their reports are
sent to the Medical Advisor.
The Medical Advisor will then
decide if more information is
needed and provide appropriate
instruction to the investigators
or schedule the report on the
agenda of the next meeting of
the Complaint Review Commit-tee
for discussion of possible
adjudication.
The Committee has consid-erable
discretion after reviewing
cases. It can request additional
information, close the case
with no further action, or refer
it externally to a state, county
or specialty society or some
other entity. It can issue a Letter
of Concern (LOC), sometimes
requiring a meeting with the
Medical Advisor. LOCs are con-fidential
but do become a part of
a physician’s private investiga-tive
file. Licensees do not meet
with the entire Board unless a
formal Complaint is issued.
Finally, the Committee can
refer the case to the Assistant
Attorney General for issuance of
a formal Complaint and Cita-tion
to appear before the entire
Board. Once a formal Com-plaint
and Citation is served, it is
subject to the Open Records Act
and is available to the public.
An appearance before
the Board is a formal legal
proceeding. Physicians, many
represented by legal counsel,
are sworn in, statements by
physicians and/or attorneys are
permitted, evidence is present-ed,
witnesses and other experts
may testify, and Board members
may question them all.
After all due diligence and
due process, the Board decides
the case.
The Board may dismiss the
case or order sanctions rang-ing
from reprimands, continuing
medical education, prescribing
limitations, practice limitations,
medical, psychiatric, boundary
and/or substance abuse evalu-ations
and potential treatment
to monetary fines, probation,
license suspension, license
revocation or any combination.
The Board’s investigators
monitor all disciplined physicians
to ensure they are in compliance
with their sanctions. 
Anatomy of a Complaint, cont. from page 1
OSBMLS WEBSITE IS NATIONAL MODEL
Page 5
Last year nearly a quarter of a million people visited the
Oklahoma State Board of Medical Licensure and Supervi-sion’s
website (okmedicalboard.org). These individuals col-lectively
logged onto the site nearly one million times, viewing
over 6.5 million pages of information.
The site serves Oklahoma medical doctors
by creating individual physician profiles
and providing a safe repository for their
application, credentialing, licensing and
practice information. This data is updated
three times daily. The site offers handy
links to other websites like the Prescription
Monitoring Program (PMP); medical/legal and
political information pertinent to the practice of
medicine; and board and committee meetings dates,
agendas and minutes.
Oklahoma MDs may renew their licenses online as well.
By this fall, new applicants for Oklahoma medical licenses
will be able to initiate the process on line.
Oklahoma Physician Profiles: Each profile contains
a complete history of a physician’s education, license and
practice experience. Only the individual physician may
access his or her profile by entering a medical license
number and Personal Identification Number (PIN).
To obtain a PIN, please call OSBMLS at 405-962-
1400.
In addition to verified information regarding a
physician’s education and license history, the
profile allows a doctor to list specialty and sub-specialties,
practice location(s), telephone and
FAX numbers, e-mail addresses, office hours,
insurances accepted and whether or not the
physician is accepting new patients. Physicians
who have never looked at their profiles are strongly
encouraged to do so to be sure all information is current.
Update profiles whenever any information changes.
Oklahoma Medical Board Welcomes New Members
Elects New Officers
Oklahoma Governor Mary Fallin
has appointed three new members to
the Oklahoma State Board of Medical
Licensure and Supervision (Board).
They are J. William Kinsinger, MD,
Oklahoma City; Hank Ross, Chicka-sha;
and Charles E. (Chuck) Skill-ings,
Shawnee.
The Board consists of nine
members appointed by the Oklahoma
Governor, seven physicians and
two public members. The physi-cians
serve seven year terms. Public
members serve concurrently with the
governor who appointed them.
Dr. Kinsinger is a gradu-ate
of Westminster College,
Fulton, MO, and the Univer-sity
Of Oklahoma College
Of Medicine. He completed
his anesthesiology residen-cy
at the University of Arkansas. He
is in private practice at Baptist Medi-cal
Center in Oklahoma City, special-izing
in obstetric anesthesiology. He
is a past president of the Oklahoma
Society of Anesthesiologists.
Mr. Ross is the mayor of
Chickasha and chair and
chief executive officer of
Ross Home Health Care,
a home health company
serving central and western Okla-homa
and one of Chickasha’s largest
employers. A native of Chickasha,
he earned a Bachelor of Science in
business administration from Okla-homa
State University and MBA from
Oklahoma City University. Mr. Ross
is a past diplomat of the American
College of Healthcare Executives
and board certified in healthcare
administration. He is president of the
Board of the Center of Family Love, a
home serving the mentally retarded,
a member of the Board of Advisors
for the First National Bank of Oklaho-ma
and past chair and current board
member of the Chickasha Economic
Development Council. He has served
on the Chickasha City Council,
City Planning Commission, and the
boards of the Chickasha Chamber
of Commerce and Chickasha School
Foundation.
Mr. Skillings is president
and chief executive officer
of Unity Health Center. He
joined Shawnee Medical
Center in 1977, serving as
Director of Emergency Medical Ser-vices
for ten years and then Director
of Medical Staff Development before
eight years as the hospital’s Senior
Vice President/Chief Operating Of-ficer.
He was named President/CEO
in 2000. Mr. Skillings is chair-elect
of the Oklahoma Hospital Associa-tion,
a member of Rotary, and Chair
of the Board of the Shawnee Rescue
Mission. He is a past member of
the board of the Shawnee Chamber
of Commerce and the Shawnee
Development Foundation. He is an
active supporter of the United Way of
Shawnee.
J. Andy Sullivan, MD, pediatric
orthopedic surgeon at the University
of the Oklahoma College of Medicine
in Oklahoma City, is the new presi-dent
of the Board.
Deborah Huff, MD, OB/GYN in
private practice in Oklahoma City, is
the Board’s new vice-president.
The terms of Dr. Sullivan and Dr.
Huff expire in July 2012.
Other members of the board
are: Jenny L. Boyer, MD,JD, Tulsa
psychiatrist; Scott W. Meyers, MD,
Tulsa dermatologist; Riaz Sirajuddin,
MD, Oklahoma City interventional
cardiologist; and G. David Casper,
MD, Oklahoma City orthopedist and
addiction medicine specialist.
Board of Medical
Licensure &
Supervision
101 NE 51st St
Oklahoma City, OK 73105
Issues & Answers, printed by Central Printing, is authorized by the Board of Medical Licensure and Supervision. 11,000 copies have been prepared at a cost of
$1357.00. Copies have been deposited with the Publications Clearinghouse of the Oklahoma Department of Libraries.
PRESORTED STANDARD
US POSTAGE
PAID
OKLAHOMA CITY, OKLA
PERMIT NO. 1548
JULY BOARD MEETING
The Oklahoma State Board of
Medical Licensure and Supervision
met on July 14, 2011 to consider
licensing and disciplinary matters.
Two MD training licenses were
issued after personal appearances
by the applicants. One PA license
was issued under standard terms of
Agreement for alcohol abuse, which
included the requirement that he
attend three 12-step meetings per
week. After being suspended and
obtaining an assessment for sexual
misconduct, one PA license was rein-stated
with probationary terms that
included counseling and obtaining a
practice monitor.
One MD license was suspended
for three months after having re-lapsed
while on probation. The
suspension will be followed by a five
year term of probation with frequent
drug testing.
Three disciplinary cases in-volved
Physician Assistants. The
first was reprimanded, fined $2500
and required to take an approved
prescribing course within one year
for prescribing CDS to herself and
a friend, and for failing to maintain
medical records. One PA surren-dered
his license after making sexual
advances to a patient. Upon assess-ment,
he was found unfit to practice
medicine with reasonable skill and
safety. The third PA surrendered his
license after having been caught of-fering
to buy methamphetamine.
Oklahoma State Board of Medical
Licensure and Supervision
P.O. Box 18256, Oklahoma City
OK 73154
or
101 NE 51st Street
Oklahoma City OK 73105
Phone: (405) 962-1400
Fax: (405) 962-1440
Web Site:
www.okmedicalboard.org